Blog Series: The Basic Breakdown of Orthopedic Injuries - Your Knee (Part 2)
Welcome to Part 2! If you need a little refresh on the anatomy of the knee, refer back to Part 1 here. If you’re ready to learn a little more about how the knee fits into your puzzle, common injuries, and a few preventive strategies, read on, friend.
The knee is one of the most common areas of pain complaints that we see in therapy. This is likely because the knee is an important weightbearing joint. It is working with every step we take, every time we stand up or sit down, etc. It gets a lot of action from the time you step out of bed in the morning to the time you lay back down at night! Not only does it do a lot of work on it’s own, it also has to play nice with your other joints and muscles (think hip, lower back, and ankle) so that it doesn’t get overstrained or stressed abnormally.
Any time we talk about one joint, especially in the lower part of the body, we have to consider how it fits into the kinetic chain. A kinetic chain is simply a chain of movement through more than one area of the body (this includes joints, muscles, nerves, etc). For example, when you walk, the knee doesn’t just move by itself. Instead it is part of a chain of movements that work together to allow you to take steps. In the instance of the knee, the chain usually starts with the foot and ankle, then the knee, the hip, and even works its way up to the lower back. If one of these areas isn’t in sync or causes abnormal movements, it can affect the body at any other point in the chain. To make it simple? A weak hip can cause knee pain, decreased ankle motion or strength can cause knee pain, and a knee problem itself can cause knee pain. Fascinating, right?
Common Injuries at the Knee
Next up I will give you a quick list of some of the most common problems we see in the knee, their “mechanism” of injury (how they often happen), and a bit more about each one. Remember, this list is just some of the common ones and most definitely doesn’t cover the whole realm of possibilities. Do you think you have something that isn’t listed and want to know a little more about it? Email me here, and I’ll see what I can do to help! Check out the list below. (WARNING: If you’re not a “sciency” person, feel free to jump on down to the Prevention Strategies and skip this section altogether!)
Ligament Tears - These injuries can include any of the ligaments listed in the Part 1 blog post, but the most commonly injured ligaments are the anterior cruciate (ACL) and medial collateral (MCL) ligaments. Sometimes they happen together, and sometimes they don’t! (; Ligament sprains and tears are most commonly seen with active people who are involved in sports or some kind of trauma (trip, fall, crash, etc.).
Let’s talk sports first...with the ACL and MCL, typically the stress injuring the knee comes from the outside and goes down and in, causing excess strain on these structures due to how they attach inside the knee. Sometimes an athlete will actually have trauma on the field or court. If the knee gets hit from the outside angle by another player, the stress from this trauma can cause one or more ligaments to be injured or potentially even rupture, or tear completely. However, blunt trauma (getting hit) doesn’t have to happen to injure these ligaments of your knee. In fast motion, there are times that abnormal movement patterns cause enough stress to damage the ligaments as well. Remember that kinetic chain? This is a perfect example of how it needs to be working well to reduce your risk of injury. If your leg isn’t stabilized through proper strength, flexibility, and movement patterns, your chance of injury without trauma goes up. ACL tears are even more common in women due to a wider pelvis and other factors.
Meniscus Tears - In the first knee blog post, I mentioned just a bit about meniscal injuries, but let’s go just a little deeper this time around. Remember that the meniscus is a layer of cartilage that gives extra cushion and play in your knee while your foot is planted on the ground, with twisting, changing directions, etc. The more active you are, the more “play” your meniscus gets, thus your risk for injury, of course, goes up a bit. The meniscus is often injured during a planting and twisting event. Some parts of the meniscus have a good blood supply, but often the areas that are torn or injured do not have a very good blood supply. Without good blood supply, the chances of the tear healing completely are fairly low. This doesn’t mean that you can’t function well with a small meniscus tear or that you automatically need surgery to clean it up, but it is a good point to remember. Research has shown that, especially in those over age 40 that surgical intervention gives no better outcomes for meniscal tears than does conservative treatment (ie. therapy, inflammatory control, etc.). Sometimes meniscal tears can be more degenerative (age-related) in this population. It is always wise to treat a meniscus tear conservatively prior to jumping into surgery. While most surgeries for meniscus tears are to “clean up” or just trim the meniscus back at the site of the tear, there are times when a meniscus tear can actually be repaired. This is less common and only in specific cases where there is good blood supply for healing of the repair itself. The recovery process is much slower for this type of surgery, as the repair must usually be protected and allowed to heal for a period before weight is put through the knee.
Patellofemoral Syndrome (anterior knee pain) - This type of knee pain is actually quite common in all types of patients (greater in women than men) and is located around the front of the knee or underneath the kneecap. The patella (fancy name for the kneecap) is a floating bone that should naturally glide in a groove on the bone underneath it. When an imbalance is present in the lower leg in one way or another (or often multiple ways), this patella doesn’t glide as nicely as it should, which causes pain. Sometimes the problem can be hip weakness that causes the knee to fall inward when squatting, doing stairs, etc. Sometimes hamstring tightness makes the quad in the front of your leg work harder, causing more stress on the kneecap. Oftentimes when we evaluate this type of knee pain in physical therapy, we find a combination of problems or deficits that are contributing to the patient’s knee pain.
While this is a short list of common problems in the knee, it is definitely not all of them! It’s a start, though, to help you understand what might be causing problems with your knee or maybe that of a friend or family member. Hopefully I haven’t bored you to the bone yet!
Prevention Strategies
Next up, how about a few preventive strategies and ideas to keep your knees healthy? In this section, I will give you some actionable things to do to prevent knee pain as you function in your everyday life, in sports, or other recreational activities.
Flexibility - Be sure that you have proper flexibility in areas such as your hamstrings, hip flexors, quads, IT bands, and calves on each side. When flexibility is compromised in one area, other areas will need to work harder to do their job. (ie. when hamstrings are tight, the quad muscle has to work harder to straighten the knee when you’re moving, resulting in increased strain on the quad and surrounding tissues).
Improve your hip and core strength - Your core is almost always the key! Our “core” helps our body stay stable so that we can move, run, jump, etc. If your core is not strong, you can imagine how much more work your legs have to do during functional activities, thus increasing your risk for injury. In therapy, I am super picky about technique when it comes to hip and core exercises! It;s not just about strengthening your core...you have to do it with proper control and good position. Holding your spine and pelvis in a neutral position and bracing your lower abdominals are two critical components, not just during actual core exercises, but as a part of all of your functional and exercise activities.
Body mechanics - This carries over a bit from the core strengthening piece of the puzzle. In therapy, we don’t just teach you what exercises to do, we teach you to carry over the ability to engage your core during functional activities. Loading the proper muscles during a squat (ie. weight balanced equally through your the balls and heels of your feet or even slightly shifted back to your heels, knees aligned over your 2nd and 3rd toes, abdominals engaged and braced) allows for a much safer and effective activity. Take the time to use good body mechanics, both in and out of the gym. Often we see injuries from being a little lax during harder household chores/activities.
Support pronated feet- As mentioned above, the kinetic chain starts where your feet hit the ground. If your feet naturally roll in at the arch or you have “flat feet”, the stress quickly travels up to the next joint, which is your knee. Consider supporting them with a good shoe. A good tennis shoe with a nice arch support goes a long way and is much better than those flip flops we all adore. When you’re on your feet for any period of time, good shoes are a must. Depending on the severity of your feet, you may also want to consider either over the counter arch supports or maybe even custom made orthotics to put your feet in a better position.
Alright friends...that’s it for the knee! If you have any questions, feel free to shoot me an email at jill@aleyawellness.com. If you’re loving this info but need a refresher on what all of these structures are to get you started, you can backtrack and check out The Basics Breakdown outlining some great basic definitions and information to get you up to speed.
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Live AND Be Well.
Xo,
Jill
Resources:
Arch Orthop Trauma Surg 2018 Dec;138(12):1731-1739. Epub 2018, Jul 4.
